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indicated in the treatment of both hypertension and congestive heart failure. Therefore, an ACE inhibitor is a rational pharmacological approach in this patient. However, the compromised liver function requires caution with any drug that requires liver metabolism for formation of the active drug moiety (i.e., prodrugs), or for drugs that are primarily eliminated by liver metabolism. With the exception of captopril and lisinopril, all of the available ACE inhibitors are prodrugs and require liver metabolism for elimination. Therefore, either captopril or lisinopril would be an appropriate ACE inhibitor in the treatment of this patient. ATI receptor antagonists are indicated for the treatment of hypertension and when converting enzyme inhibitors are contraindicated in the therapy of congestive heart failure. Of this class of compounds, eprosartan, val-sartan, and telmisartan do not require liver metabolism to produce an active compound.
case Study Congestive Heart Failure with Complications
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